National Rural Health Mission (NRHM)

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29-Jul-2022: Initiatives for ensuring healthcare in tribal areas

There are various Government/Non-Government institutional mechanisms and survey agencies which generate data on tribal healthcare on a periodic basis. Rural Health Statistics (RHS) provides details of infrastructure and human resource in tribal areas. National Family Health Survey (NFHS) provides details on major health indicators about maternal and child health among Scheduled Tribes. Census of India provides population and household details including Tribal areas.  National Sample Survey provides household surveys on various socio-economic subjects.

The Expert Committee on Tribal Health titled, “Tribal Health in India: Bridging the Gap and a Roadmap for the Future” came in 2018 which gives details on the status of tribal health. The Report of the Committee pieces together the health status of the tribal populations, did a detailed analysis of the health situation in tribal areas, maps out the disease burden, discusses the challenges in areas of infrastructure, facilities, Human resource, financing, participation in planning etc., and makes recommendations for improving health outcomes for tribal populations.  The main recommendations of the Committee include – strengthen access to comprehensive primary healthcare by establishing health and wellness centres, provide insurance for access to secondary and tertiary care; enhance human resource via community health officers/mid-level healthcare providers, enhancing capacities/roles of ASHA, task sharing and shifting etc.; community mobilization and IEC; use of technology to increase access to health services; strengthening school health program; integration of tribal health practitioner in primary care; increased financing for tribal health, for instance through Tribal Sub Plan (TSP).

The NHM focuses on universal approach and hence all the Health and Family Welfare Schemes run under the umbrella of NHM is applicable and available in all the States/UTs including Odisha. Under the National Health Mission (NHM), financial and technical support is provided to States/UTs to strengthen their health care systems including setting-up/upgrading public health facilities and augmenting health human resource on contractual basis for provision of equitable, affordable healthcare to all its citizens particularly the poor and vulnerable population in the tribal areas based on requirements posed by the States in their Programme Implementation Plans (PIPs) within their resource envelope.

Various supports under NHM for better healthcare for beneficiaries in tribal areas are as follows:

  • Ayushman Bharat- Health and Wellness Centres (HWCs) are established by transforming the Sub-Health Centres (SHCs) and Primary Health Centres (PHCs), as part of the Ayushman Bharat - the flagship programme of Government of India, to deliver twelve packages of Comprehensive Primary Health Care (CPHC) that includes preventive, promotive, curative, palliative and rehabilitative services which is universal, free and close to the community.
  • The population norms for setting up Health Facilities in vulnerable areas are relaxed. Against the population norms of 5,000, 30,000 and 1,20,000 for setting up of SHC, PHC and CHC, the norm is 3,000, 20,000 and 80,000 respectively in vulnerable areas such as remote, tribal, desert and hard to reach areas.
  • Under NHM, States/UTs have been given flexibility to deploy Mobile Medical Units (MMUs) to provide a range of health care services for the population particularly living in remote, in-accessible, un-served and under-served areas, as per the needs identified by the respective States/UTs.
  • To minimize the Out-of-Pocket Expenditure incurred on health services, National Free Drugs Service Initiative and National Free Diagnostic Service Initiative have been rolled out.
  • The ASHA programme guidelines provide for recruitment of ASHA at habitation level in hilly, tribal and difficult areas. (Well below the national norm of one ASHA at a population of about 1000).
  • Government of India is supporting states in implementation of National Ambulances Services under NHM for free transportation of sick patients to the health facilities. States are free to place these ambulances at a lower population norm or as per time to care approach so that these ambulances are easily accessible by all.
  • Further, all tribal majority districts whose composite health index is below the State average have been identified as High Priority Districts (HPDs) and these districts receive more resources per capita under the NHM as compared to the rest of the districts in the State.

19-Jul-2022: Achievements made under NRHM and NUHM

National Health Mission (NHM) envisages achievement of universal access to equitable, affordable & quality health care services that are accountable and responsive to people’s needs. NHM encompasses its two Sub-Missions, the National Rural Health Mission (NRHM) and the National Urban Health Mission (NUHM). The main programmatic components include Health System Strengthening in rural and urban areas, Reproductive-Maternal- Neonatal-Child and Adolescent Health (RMNCH+A) and Communicable and Non-Communicable Diseases.

Public Health & Hospital is a State subject, hence, the responsibility of strengthening public healthcare system, especially to rural & vulnerable population, including strengthening of existing health/ medical facilities lies with the respective State/ UT Governments. Under National Health Mission (NHM), Ministry of Health & Family Welfare, Government of India provides financial and technical support to States/UTs including support for health/ medical facilities, upto District Hospital level, based on the proposals submitted by States/UTs in their Program Implementation Plans (PIPs). Government of India provides approval for the proposals in the form of Record of Proceedings (RoPs) as per available resources.

Government of India extends supports to states to expedite the process of creating health infrastructure as per Indian Public Health Standards. These standards include norms for services, infrastructure, human resource, diagnostics, equipment, medicines etc.

Under Ayushman Bharat, the existing Sub-health Centres (SHCs) and Primary Health Centres (PHCs) are transformed into AB-HWCs to deliver twelve packages of Comprehensive Primary Health Care (CPHC) that includes preventive, promotive, curative, palliative and rehabilitative services which is universal, free and close to the community. Another essential component of Ayushman Bharat Health & Wellness Centres (AB-HWCs) is the roll out of tele-consultation services through ‘eSanjeevani’. This platform provides telemedicine services for the communities through a hub and spoke model which connects AB-HWCs (spokes) to District Hospitals/Medical colleges (Hubs) for specialist consultation services. Teleconsultation services are aimed to improve access of specialist services to the communities, especially in the rural areas.

Further, following steps have been taken for strengthening healthcare systems to cater to future healthcare needs:

  • “Emergency Response and Health Systems Preparedness Package – II (ECRP-II)” for Rs. 23,123 Crore, including Central Component, was approved by Cabinet to extend support to the States/UTs for establishing District Paediatric Units (including Oxygen Supported beds and ICU beds) in all the Districts of the Country. Besides, support is also provided to increase the availability of ICU beds in Government health facilities. Maintaining buffer stock of essential medicines required for effective COVID management, in addition to provision for required drugs and diagnostics, is also supported. Support is also available for establishing field hospitals (100 bedded or 50 bedded units), wherever required.
  • PM Ayushman Bharat Health Infrastructure Mission (PM-ABHIM) with an outlay of Rs. 64,180 crores till 2025-26 envisages increased investments in public health and other health reforms to provide better access to health in rural areas by i) Strengthening of Health and Wellness Centres in villages and cities for early detection of diseases; ii) Addition of new critical care-related beds at district level hospitals; iii) Support for Block Public Health Units (BPHU) in 11 high focus States; and iv) Integrated district public health laboratories in all districts.
  • The recommendations of 15th Finance Commission (FC-XV) w.r.t Health Grants through Local Governments announced in Union Budget 2021-22, addresses the gaps in Primary Healthcare facilities.
  • The Pradhan Mantri Swasthya Suraksha Yojana (PMSSY) aims at correcting regional imbalances in the availability of affordable tertiary healthcare services and to augment facilities for quality medical education in the country. The Scheme has two components, namely, (i) Setting up of All India Institute of Medical Sciences (AIIMS); and (ii) Upgradation of existing Government Medical Colleges/ Institutions (GMCIs). So far setting up of 22 new AIIMS and 75 projects of upgradation of GMCIs have been approved under the Scheme in various phases. The setting up of AIIMS contains Medical College, Nursing College, Hospital, Trauma Centre, Emergency, Blood Bank, ICU, Diagnostic & Pathology, Research etc. Upgradation of GMCIs under PMSSY broadly involves construction of Super Speciality Block (SSB) and/ or Trauma Centre/ or other facilities and/ or procurement of medical equipment.
  • Under the Centrally Sponsored Scheme (CSS) , ‘Establishment of new medical colleges attached with existing district/referral hospitals’, establishment of 157 medical colleges has been sanctioned.

12-Feb-2021: Healthcare Scheme for SC/ST Women

“Public Health and Hospitals” being a State subject, the primary responsibility to provide quality healthcare in public healthcare facilities including to SC/ST category women and their children lies with the respective State Governments.

To address the healthcare challenges, particularly in rural areas, the National Rural Health Mission (NRHM) was launched in 2005 to supplement the efforts of the State/UT Governments to provide accessible, affordable and quality healthcare to all those who access public health facilities. Currently, NRHM is a sub-mission of National Health Mission (NHM).

The States are given flexibility to propose specific interventions for SC/ST areas and beneficiaries including for women and their children and are supported under National Health Mission, based on their proposals.

NHM support is also provided for provision of a range of free services including for SC/ST women and children, related to maternal health, child health, adolescent health, family planning, universal immunization programme and for other major diseases such as Tuberculosis, vector borne diseases like Malaria, Dengue and Kala Azar, Leprosy, etc.

Other major initiatives supported under NHM include Janani Shishu Suraksha Karyakram (JSSK) (under free drugs, free diagnostics, free blood and diet, free transport from home to institution, between facilities in case of a referral and drop back home is provided), Rashtriya Bal Swasthya Karyakram (RSSK) (which provides newborn and child health screening and early interventions services free of cost for primary defects, diseases, deficiencies and developmental delays to improve the quality of survival), Pradhan Mantri Surakshit Matritva Abhiyan (PMSMA) to improve coverage of ANC and improved identification and tracking of high risk pregnancies and Mission Indradhanush (MI) and Intensified Mission Indradhanush (IMI) in improving immunisation coverage.

Various interventions that are implemented for better healthcare in SC/ST areas and beneficiaries are as follows;

  • The population norms for setting up Health Facilities in tribal areas are relaxed. Against the population norms of 5,000, 30,000, and 1,20,000 for setting up of Sub Centre, PHC and CHC respectively, in tribal and desert areas its 3,000, 20,000 and 80,000.
  • Relaxed norms for Mobile Medical Units (MMUs).
  • All tribal majority districts whose composite health index is below the State average have been identified as High Priority Districts (HPDs) and these districts receive more resources per capita under the National Health Mission (NHM) as compared to the rest of the districts in a State.
  • Implementation of Free Drugs and Free Diagnostics Service Initiatives.
  • SC/ST households are covered under Ayushman Bharat, Pradhan Mantri Jan Arogya Yojana (AB-PMJAY) for health coverage up to Rs 5 Lakh per family per year as per Socio Economic Caste Census (SECC).